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Impact of Obesity on Sentinel Lymph Node Mapping in Patients with Newly Diagnosed Uterine Cancer Undergoing Robotic Surgery

  • Gynecologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to determine the impact of obesity on the rate of successful sentinel lymph node (SLN) mapping in patients with uterine cancer undergoing robotic surgery, and compare SLN detection rates using indocyanine green (ICG) versus blue dye.

Methods

We reviewed robotic cases undergoing SLN mapping with a cervical injection from January 2011 to December 2013 using either blue dye or ICG with near-infrared (NIR) fluorescence imaging. Data were stratified by body mass index (BMI) and the dye used. Appropriate statistical tests were applied.

Results

Overall, 472 cases were identified. Bilateral mapping was successful in 352 cases (75 %), and unilateral mapping was successful in 73 cases (15 %). Bilateral mapping was achieved in 266 (85 %) of 312 ICG cases compared with 86 (54 %) of 160 blue-dye cases (p < 0.001). Cases with successful bilateral mapping had a median BMI of 29.8 kg/m2 (range 16.3–65.3 kg/m2); cases with no mapping had a median BMI of 34.7 kg/m2 (range 21.4–60.4 kg/m2) (p = 0.001). With increasing BMI, there was a significant decrease in successful bilateral mapping rates for both the ICG (p < 0.001) and blue-dye groups (p = 0.041); however, the use of ICG resulted in better bilateral (p = 0.002) and overall (p = 0.011) mapping rates compared with the use of blue dye in all BMI groups.

Conclusions

ICG results in a higher overall and bilateral SLN detection than blue dye in women with uterine cancer. Successful mapping decreases with increasing BMI irrespective of the dye used; however, it is significantly improved with the use of ICG and NIR fluorescence imaging compared with blue dye.

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Funding

This study was funded in part by the Cancer Center core grant P30 CA008748, which provides funding to institutional cores, such as Biostatistics and Pathology, which were used in this study.

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Authors and Affiliations

  1. Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Ane Gerda Zahl Eriksson MD, Margaret Montovano, Anna Beavis MD, Nadeem R. Abu-Rustum MD, Ginger J. Gardner MD, Oliver Zivanovic MD, Richard R. Barakat MD, Carol L. Brown MD, Douglas A. Levine MD, Yukio Sonoda MD, Mario M. Leitao Jr. MD & Elizabeth L. Jewell MD

  2. Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Robert A. Soslow MD

  3. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Qin Zhou MA

Authors
  1. Ane Gerda Zahl Eriksson MD
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  2. Margaret Montovano
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  3. Anna Beavis MD
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  4. Robert A. Soslow MD
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  5. Qin Zhou MA
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  6. Nadeem R. Abu-Rustum MD
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  7. Ginger J. Gardner MD
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  8. Oliver Zivanovic MD
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  9. Richard R. Barakat MD
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  10. Carol L. Brown MD
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  11. Douglas A. Levine MD
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  12. Yukio Sonoda MD
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  13. Mario M. Leitao Jr. MD
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  14. Elizabeth L. Jewell MD
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Corresponding author

Correspondence to Elizabeth L. Jewell MD.

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Eriksson, A.G.Z., Montovano, M., Beavis, A. et al. Impact of Obesity on Sentinel Lymph Node Mapping in Patients with Newly Diagnosed Uterine Cancer Undergoing Robotic Surgery. Ann Surg Oncol 23, 2522–2528 (2016). https://doi.org/10.1245/s10434-016-5134-2

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  • DOI: https://doi.org/10.1245/s10434-016-5134-2

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